BWFE2017-012378-4y5 CALLE TAMPICO 4.4 Qu4z
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BWFE2017-0123
Property Address: 81688 RUSTIC CANYON DR
APN: 764540042
Application Description: HOLMUND / 25LF OF COMBO WALL WEST PL AT CASITA
Property Zoning:
Application Valuation: $1,800.00
Applicant:
DAZ
P 0 BOX 5083
LA QUINTA, CA 92253
. LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my License is in.full force and effect.
License Class: B icense No.: 944325
Dat V ')Iy Contractors/
(__/
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for the permit to file a
signed statement that he or she is licensed pursuant to the provisions of the
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
3 of the Business and Professions Code) or that he or she is exempt therefrom and the
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a
permit subjects the applicant to a civil penalty of not.more than five hundred dollars
($500).:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for sale.
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who does the work
himself or herself through his or her own employees,.provided that the improvements
are not intended or offered for sale. If, however, the building or improvement is sold
within one year of completion, the owner -builder will have the burden of proving that
he or she did not build or improve for the purpose of sale.).
( ) I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
(� I am exempt under Sec. B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Na
Lender's Add
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
JOHN & JANE HOLMUND
81688 RUSTIC CANYON DR
LA QUINTA, CA 92253
Contractor:
DAZ
P 0 BOX 5083.
LA QUINTA, CA 92253
(760)285-3793
Llc. No.: 944325
Date:
7/7/2017
D
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
0or which this permit is issued.
I ave and will maintain workers' compensation insurance, as required by
Section 0 of the Labor Code, for the performance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9168769
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I Pa d become subject to the
workers' compensation provisions of Section 3700 )ode, I shall forthwith
comply with_those provisions.
Da Applica
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application , the owner, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is
not commenced within 180 days from date of issuance of such permit, or cessation of.
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city t nter upon the
above --menti ned property for inspection purposes. /
Date:.' Signature (Applicant or Agent):/
Date: 7/7/2017
Appliyation Number: BWFE2017-0123
Owner:
Property Address: 81688 RUSTIC CANYON DR
JOHN & JANE HOLMUND
APN: 764540042
81688 RUSTIC CANYON DR
Application Description: HOLMUND / 25LF OF COMBO WALL WEST PL AT CASITA
LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $1,800.00
Applicant:
Contractor:
DAZ
DAZ
P 0 BOX 5083
P O BOX 5083 _
LA QUINTA, CA 92253
LA QUINTA, CA 92253
(760)285-3793
---------------------------------------------------------------------------------------------
Llc. No.: 944325
Detail: 25LF OF COMBO WALL AT WEST PL AT CASITA. [CITY SPECIFICATIONS] PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO, PAINT, OR
TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. THE AREA BETWEEN THE BACK OF CURB AND ANY FENCING SHALL BE LANDSCAPED,
HAVE A SUITABLE PERMANENT IRRIGATION SYSTEM, AND BE CONTINUOUSLY MAINTAINED BY THE PROPERTY OWNER. 2016 CALIFORNIA BUILDING CODES.
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT
QTY
AMOUNT
RETAINING/COMBINATION WALL EA 50LF 101-0000-42400
0
$15.20
DESCRIPTION ' ACCOUNT
QTY
AMOUNT
WALL/FENCE - FIRST 100 LF 101-0000-42404
0
$50.67
DESCRIPTION ACCOUNT
QTY
AMOUNT
WALL/FENCE - FIRST 100 LF PC 101-0000-42600
0
$63.33
Total Paid for BLOCK WALL: $129.20
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BSAS SB1473 FEE
101-0000-203060
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Bin #
Permit #
flj2'LJ
Project Address: C l (p Dt
City of b Quinta
Buifding & Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
Owner's Name: Vw��
A. P. Number: b
Address:
Legal Description:
City, ST, Zip: ,
Contractor: a r•
o
Telephone:
Address: to, C) 1 60f 5 7
Project Description:
City, ST, Zip:
0C C�
A
Telephone:
.2-5 t�
State Lie. # :
City Lie. #;
Ar 11
Arch.,-Engr., Designer:
Address:
City, ST, Zip:
Telephone:
an cY•
Construction Type: Occupancy:
P
State Lie. i.
aJtYPe circle one : New Addn AIter Re ir
Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:.
APPLICANT: DO NOT WRITE BELOW THIS LINE
N Submittal Req'd Rcc'd TRACKING PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance.
Title 24 Calcs.
Plans picked up
Construction '
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical .
Subcontactor List
Called Contact Person
Plumbing
Grant Decd
Plans picked up
S.M.I.
1I.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
'"! Review, ready for correctionstissuc
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. \Vks. Appr
Date of permit issue
School Fees,
'
Total Permit Fees '
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CITY OF LA QUINTA
BUILDING & SAFETY DEF".
APPR0VED
FOR CONSTRUCTION
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